Medical Malpractice Claims Within Cardiology from 2006 to 2015

With increasing healthcare costs and the high cost of spending driven by "defensive medicine," shedding light on recent litigation trends is critical for understanding current tort patterns, especially in the field of cardiology, a specialty with higher rates of malpractice suits than average. Understanding the characteristics of these liability claims and common types of patient injuries can aid cardiologists in mitigating malpractice risk and better patient care. Thus, the objective of this study was to characterize current malpractice trends in the field of cardiology and common sources of patient injury. An analysis of malpractice litigation claims from 2006 to 2015 in cardiology was performed on a database of nationwide professional liability insurers, health systems, and community hospitals. Both the total number of claims and annual indemnity payments in cardiology have seen an overall increase from 2006 to 2015. Of the 1,538 claims observed, the leading allegations were improper medical treatment and diagnostic error. However, despite the large number of claims, most cardiology claims during this decade were either decreased, denied, or dismissed (68%) and the plurality of the remainder was settled outside of court (30%). In conclusion, from 2006 to 2015, rates of cardiology malpractice claims and amount paid in compensation have increased substantially in the United States. Further understanding of the characteristics of these lawsuits can aid cardiologists in avoiding common sources of injury to improve patient care.

THE FUTURE OF CARDIOVASCULAR CARE: FROM AFFORDABLE CARE TO THE ACADEMIC MEDICAL CENTER

We are presently seeing exponential advances in medical knowledge and development of therapeutic and diagnostic tools. We have also begun to experience an historic restructuring of our health care system. But health care costs continue to rise, disparities persist, and the chaotic, disjointed, and often thoughtless discourse in Washington threatens to roll back the prior advances. Improvement in patient care will be severely stymied if the threats to academic medical centers are not countered. This paper will explore our present state through the lens of cardiovascular care. It will 1) examine clinical trends; 2) dissect the value and challenges to the Patient Protection and Affordable Care Act; 3) highlight limitations and alternatives to relying on the federal government; and 4) present the Academic Medical System construct, as a structure designed to retain and advance the academic mission.

[ANMCO/SIT Consensus document: Telemedicine and the emergency/urgency care network]

Telemedicine has deeply innovated the field of emergency cardiology, particularly the treatment of acute myocardial infarction. The ability to record an ECG in the early prehospital phase, thus avoiding any delay in diagnosing myocardial infarction with direct transfer to the cath-lab for primary angioplasty, has proven to significantly reduce treatment times and mortality. This consensus document aims to analyze the available evidence and organizational models based on a support by telemedicine, focusing on technical requirements, education and legal aspects.

[Eligibility to competitive and non-competitive sports activity in Cardiology]

Subjects with heart diseases at risk of sudden death may be free from symptoms and be able to perform high-level sports activities. Preparticipation screening helps to detect these diseases, reducing the risk of sudden death in athletes. Fortunately, sudden death in athletes is a rare event (1-2/100 000 in subjects aged <35 years). As a consequence, it is not clear whether extensive preparticipation screening is cost-effective. In Italy pre-participation screening is mandatory for both agonistic and nonagonistic sports, whereas in the United States it is not requested. In addition, many US authors suggest that compulsory medicine visits are in conflict with the freedom of any people to self-determine its own destiny. In the presence of heart disease, international guidelines exist that provide recommendations for sports eligibility. Although all of them are similar, US guidelines are more permissive. Guidelines are not laws. However, in case of legal disputes, they are taken into account and, hence, it is a good rule to know and follow them.

Lawyers scuttle hopes of international court for fraudulent science

The European Heart Journal has often joined calls to counter fraud in science, but a bitter disagreement between a clinical researcher and a statistician has now reached the British courts and threatens to derail a growing belief that there are ways to minimize such activities.A fictitious report by Barry Charles PhD.

[Long-term mechanical circulatory support: where do we stand in 2013?]

With the advent of new technologies, experience with long-term mechanical circulatory support (MCS) is rapidly growing. Candidates to MCS are selected based on concepts, strategies and classifications that are specific to this indication. As results drastically improve, supported by stronger scientific evidence, the trend is towards earlier implantation. An adequate pre-implant follow-up is mandatory in order to avoid missing the best window of opportunity for implantation. While on chronic support, the hemodynamic profile of patients with continuous-flow ventricular assist devices is unique and remarkably influenced by the hydration status. Optimal management of these patients from the pre-implant phase to the long-term support phase requires a multidisciplinary approach that is similar to that already long validated for organ transplantation.

[2011 ESC guidelines on the diagnosis and treatment of peripheral artery diseases]

In this article, we present the 2011 guidelines on the diagnosis and treatment of peripheral artery diseases. The document covers the diagnostic modalities and therapeutic strategies for the atherosclerotic disease of the extra-cranial carotid, mesenteric, renal, upper and lower extremity arteries indicating the class and level of evidence of the recommendations.

Patient reactions to confidentiality, liability, and financial aspects of informed consent in cardiology research

BACKGROUND

Although the informed consent process is supposed to help potential research participants make informed and voluntary decisions about participating in research, little is known about how participants react to language in the informed consent document and whether their reactions are related to their willingness to enroll in clinical trials. We examined the relationship between patients' reactions to standard informed consent language and their willingness to participate in a hypothetical clinical trial.

METHODS AND RESULTS

We simulated the consent process for a hypothetical cardiology clinical trial with 470 patients in an outpatient cardiovascular medicine clinic at a large academic medical center. We analyzed the spontaneous comments and questions that participants made during the interviews about each section of the informed consent document. Few participants made positive comments. Participants made the most negative comments about the sections on risks, study purpose or protocol, and payment for injury. Having a negative reaction to any section was associated with a lower likelihood of participating in the clinical trial. Using a multivariable model, we found that negative reactions in the patient rights, financial disclosure, and confidentiality sections predicted willingness to participate (P<0.001).

CONCLUSIONS

Recognizing elements of informed consent that elicit questions and concerns from potential research participants may help investigators design clinical research trials and model language in a way that reduces concerns or increases participant understanding, thereby enhancing informed consent for research.

Accreditation for cardiovascular imaging: setting quality standards for patient care

The accreditation of laboratories performing noninvasive cardiac procedures is now routinely available and often required by insurance companies. In this article, the history of the accreditation for cardiac procedures is reviewed, the process explained, and the number of accredited laboratories listed. Decision pathways are listed, and common reasons for a laboratory being delayed in approval are described specific for the various modalities. Some of the common compliments and concerns received by the Intersocietal Accreditation Commission are described.

The regulatory background of nuclear cardiology in Europe: a survey by the European Council of Nuclear Cardiology

PURPOSE

Nuclear cardiology is a well-validated, non-invasive imaging modality that is highly cost-effective as a diagnostic and prognostic tool in the evaluation of patients with known or suspected coronary artery disease. However, the number of procedures in Europe is very far from that which would be expected on the basis of epidemiological data, particularly when comparison is made with the USA. As a preliminary step for future action aimed at improving and increasing nuclear cardiology practice in Europe, the European Council of Nuclear Cardiology performed a survey to identify the regulatory issues and the training components pertaining to the practice of nuclear cardiology.

METHODS

a questionnaire was sent to 31 national nuclear medicine societies and to 40 national cardiology societies. The main areas covered by the survey were: (1) the license requirements, (2) the theoretical and practical aspects of training and (3) supervision of the stress test during a nuclear cardiology study.

RESULTS

The results show that, in a setting of wide heterogeneity of national regulations, education and professional practice, nuclear medicine is a restricted and closely regulated specialty. This situation guarantees the quality and safe use of radionuclides; at the same time, however, it limits integration of nuclear medicine into the clinical arena.

CONCLUSION

Cardiologists should become more involved in nuclear cardiology, to further stimulate the use of this powerful diagnostic and prognostic imaging modality.

[Why is integrated health care appropriate for modern German cardiology?]

Integrated Health Care is a new tool in German legislative means to overcome the traditional separation of outpatient and inpatient health care sectors. In this paper, it is outlined, that cardiology meets several criteria that make the introduction of Integrated Health Care especially in cardiology promising. Among these criteria, evidence-based medicine, guideline-based medicine, good statistical information, large numbers of performed procedures, high costs of performed procedures, performance of procedures both in the outpatient and inpatient sectors, chronic course of treated diseases, a high degree of dependence on other medical specialities as well as a high need for the implementation of innovations in clinical cardiology are mentioned.Concluding, the paper explains the purposes of this supplement for the comprehension of different views on Integrated Health Care in cardiology as well as the information on already implemented Integrated Health Care. These experiences should facilitate the formulation of the requests for the cardiology community for new definitions of Integrated Health Care beyond 2007/ 2008.

Kriterienkatalog für die Integrierte Versorgung in der Kardiologie

This paper comprises criteria for projects of Integrated Health Care in cardiology. With these criteria, projects can be assessed for their congruence with essentials that have been assigned by the German Cardiac Society, the Association of German Hospital Cardiologists and the Association of German Practice Cardiologists. The main purpose is to ensure that evidence-based medicine is the basis for the contracts and that all valid guidelines have been observed when services have been agreed. Possibly this paper may be the basis to award an approval to projects that meet all the criteria. This paper is no model contract.